Understanding changing patterns of survival and hospitalization for heart failure over two decades in New Zealand: utility of ‘days alive and out of hospital’ from epidemiological data

Wasywich, Cara A.; Gamble, Greg; Whalley, Gillian A.; Doughty, Robert N.

doi:10.1093/eurjhf/hfq027

Cited by 80 publications

(113 citation statements)

References 24 publications

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“…The steady decline in HF incidence is consistent with recent studies from Scotland, 3 Sweden, 17 Australia, 18 New Zealand, 19 Canada, 20 and the United States. 21 Although the magnitude of decline in England exceeds these studies, our analysis is more contemporary and involves community as opposed to hospitalized patients.…”

Section: Epidemiology: Overall Ratessupporting

confidence: 89%

Community Care in England

Hawkins

Scholes²,

Bajekal³

et al. 2012

Circulation

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Background-Socioeconomic deprivation is associated with increased heart failure (HF) incidence, hospitalization rates, and mortality. However, whether the delivery of survival-enhancing medical therapy is equitable remains uncertain. We examined secular trends in the uptake of key medical therapies (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, ␤-blockers, spironolactone) stratified by socioeconomic circumstances in patients with HF. Secondary analyses examined trends in HF incidence, prevalence, and survival. Methods and Results-This study was a cross-sectional observational analysis of nationally representative primary care data from England. Treatments for patients with HF in 1999 and 2007 (nϭ13 330) were extracted from the General Practice Research Database. Socioeconomic circumstances were defined with the Index of Multiple Deprivation 2007, a weighted composite of 7 area-level deprivation domains. Treatment uptake estimates were age standardized. The incidence and prevalence of HF decreased year to year. Although clear socioeconomic gradients in both the incidence and prevalence of HF were apparent, the absolute difference between most and least deprived reduced over time. Uptake of therapies improved over time in both men and women. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker uptake increased from 46% to 64%, ␤-blocker uptake from 12% to 41%, and spironolactone uptake from 3% to 20%. Modest age and sex inequalities were apparent. However, no consistent socioeconomic gradients were observed in either treatment or case fatality. Conclusions-Socioeconomic gradients in the incidence and prevalence of HF are reducing. Treatment is generally equitable and independent of socioeconomic circumstances. Most important, no significant inequality in outcomes was apparent. Future strategies should continue to address inequalities in the underlying causes of HF and to increase overall treatment levels further.

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Section: Epidemiology: Overall Ratessupporting

confidence: 89%

Community Care in England

Hawkins

Scholes²,

Bajekal³

et al. 2012

Circulation

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“…In addition, there were no significant differences in average length of stay between geographic regions within Canada. The average duration for an HF hospitalization in the RAFT population is similar to what has been reported by other investigators in other geographic regions, including Canada, 20 Italy, 21 New Zealand, 22 and Spain. 23 Shorter lengths of stay have been reported in the United States by the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) investigators.…”

Section: Crt and Hospitalizations For Hfsupporting

confidence: 87%

Impact of Cardiac Resynchronization Therapy on Hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial

Gillis

Kerr

Philippon³

et al. 2014

Circulation

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4-8 The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) reported that patients with mild to moderate HF and depressed left ventricular systolic function in association with an intraventricular conduction delay randomized to an implantable cardioverter-defibrillator (ICD) plus CRT experienced improved survival and were significantly less likely to be hospitalized for HF compared with the group randomized to ICD therapy alone. 8 This prespecified study within RAFT presents a detailed analysis of the causes of hospitalization, hospitalization rates, and hospitalization lengths of stay in the RAFT cohort. Clinical Perspective on p 2030 MethodsThe study design 9 and results of RAFT 8 have previously been published. Patients were enrolled at 24 centers in Canada, 8 centers inBackground-This study reports the impact of cardiac resynchronization therapy (CRT) on hospitalizations in patients randomized to implantable cardioverter-defibrillator (ICD) or ICD-CRT in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). Methods and Results-Hospitalization rates and lengths of hospital stay were compared between the 2 groups. At the 18-month follow-up, the numbers of patients hospitalized for any cause were similar in the ICD (n=351, 38.8%) and ICD-CRT (n=331, 30.0%) groups. The number of patients hospitalized for heart failure was significantly lower in the ICD-CRT (n=101, 11.3%) compared with the ICD (n=141, 15.6%; P=0.003) group. The number of patients hospitalized for a device-related indication was similar in the ICD-CRT group (n=147, 16.4%) and ICD group (n=126, 13.9%; P=0.148). The total number of hospitalizations for any cause (n=1448 versus n=1553; P=0.042), any cardiovascular cause (n=667 versus n=790; P=0.017), and any heart failure cause (n=385 versus n=505; P<0.0001) was significantly lower in ICD-CRT group compared with the ICD group, whereas the number of hospitalizations for device-related causes was significantly higher in the ICD-CRT group compared with the ICD group (246 versus 159; P<0.001). Although the reduction in hospitalizations for heart failure in the CRT-ICD group was offset by an increased number of hospitalizations for device-related indications, the length of hospital stay for any cause was significantly shorter in the ICD-CRT group (8.83±13.30 days) compared with the ICD group (9.59±14.40 days; P=0.005). Conclusion-ICD-CRT therapy significantly reduces hospitalizations and total days in hospital in patients with New York Heart Association class II/III heart failure compared with ICD therapy despite increased admissions for device-related indications. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251251.

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“…[16][17][18][19][20][21] However, incident and total admission rates decreased steadily thereafter. [22][23][24][25][26][27][28] Studies that examined population-based trends in the incidence of heart failure in the decades leading up to the 1990s showed weak correlation with hospital admission trends. [29][30][31] More recently, however, reductions in admissions because of heart failure appear to reflect an actual decline in the incidence of heart failure.…”

Section: E768mentioning

confidence: 99%